AccountId: 011433970860
ContactId: 531ba41d-d83c-4015-ad08-738f34717dcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668369 ms
Total Talk Time (AGENT): 189303 ms
Total Talk Time (CUSTOMER): 235254 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/531ba41d-d83c-4015-ad08-738f34717dcf_20250206T14:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good day. My name is [PII]. Last name initial is [PII] I am calling from Laboratory Corporation of America. For training and quality purposes. This line will be recorded, and I am calling about the claim status we submitted for one of our mutual patients. Can you please help me with this?
[AGENT][NEUTRAL] Mhm. Sure, I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Our callback number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Oh, the default policy ID number is 02441226.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII]. The date of birth is [PII].
[AGENT][POSITIVE] OK, thank you Miss [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is 11-25-2024 and the total bill amount is $127. I'm sorry, it's $127.75.
[AGENT][NEUTRAL] All right, let me see if this is your claim. And for the future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And bear with me.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the procedure codes for me?
[CUSTOMER][NEUTRAL] Yeah, sure, just a moment, let me just double check it here.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] So for the first procedure is 80061 and the second one is 83036. That's the procedure codes that was denied.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And you said it was um
[AGENT][NEUTRAL] I don't see that claim. Do you have a claim number, Miss [PII]?
[CUSTOMER][NEUTRAL] Just a moment, let me uh check it here.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. Upon checking, there's no claim number.
[AGENT][NEUTRAL] Yeah, there's no claim on file for us. Um, we have not received that claim as of today.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] But uh the member was um registered uh to your end, right? But there's no claim.
[AGENT][NEUTRAL] I can give you the effective date. One moment, let me go ahead and get that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And I'm taking one more time.
[CUSTOMER][NEUTRAL] Alright, I will also try to check if I can find the claim number here on me so we can check the status of the claim.
[AGENT][NEUTRAL] OK. No, we do not have it. Um, the effective date on this policy is [PII] and it is active at the moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, I'm just checking here on my end if I can check uh the claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have here um reference number. Can we try this one?
[AGENT][NEUTRAL] What's the reference number?
[CUSTOMER][NEUTRAL] It's 02441389.
[AGENT][NEUTRAL] That is the policy number.
[AGENT][NEUTRAL] There's no claims under that policy, mhm.
[CUSTOMER][NEUTRAL] Mhm. Oh, alright.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Do you have any other numbers besides the reference number?
[CUSTOMER][NEUTRAL] Oh, I found here the claim number 3,536,560.
[AGENT][NEUTRAL] 560. OK, let me see what.
[AGENT][NEUTRAL] That pulls one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm waiting on the system, bear with me.
[CUSTOMER][POSITIVE] Just, um, it's OK. Just take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like um based on the information on this claim, we processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um.
[AGENT][NEUTRAL] We send a benefit amount of $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this $100 is was already paid, right?
[AGENT][NEUTRAL] Yes, um, we pay that on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII], right, last year.
[AGENT][NEUTRAL] Correct, yes, last year. Mhm.
[CUSTOMER][NEUTRAL] Mhm. And do you have the check number for this one?
[AGENT][NEUTRAL] Check number is 2016549.
[CUSTOMER][NEUTRAL] All right, just a moment, we'll just take note of this one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And may I ask if is there any patient responsibility indicated on your end?
[AGENT][NEUTRAL] And this particular policy is a limited hospital indemnity plan. Um, it is not a major medical. So we don't have any contractual involvement on the remaining of the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] Just a moment, let me just put it here on my documentation.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So for the uh denied CPT codes, this was a minor diagnostic exam that was not covered by this insurance, right?
[AGENT][NEUTRAL] Uh, the denial reason for the other exams are, let me see, one moment, which, the only one that it looks like we denied was 93036. Um, it looks like the calendar, your maximum for the benefit has been exhausted.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That is the denial. The maximum benefit is the $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright thank you so much for that information. I will just um check it here.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Do you have the patient responsibility of this member or no?
[AGENT][NEUTRAL] Again, we're not the major medical, so no, there's no contractual involvement on the remaining of the claim. There's nothing applied towards the deductible co-payment or co-insurance and there's no contractual involvement, so no, we don't have that information.
[CUSTOMER][NEUTRAL] Oh alright I'll take note of this one and I think that would be all for documentation purposes, can you please spell out your first name and provide your last name initial?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sure. My first name is [PII]. That's [PII]. Last initial is [PII].
[AGENT][NEUTRAL] And we don't have reference numbers. my name in today.
[CUSTOMER][NEUTRAL] All right, and also.
[CUSTOMER][NEUTRAL] Oh, alright.
[CUSTOMER][NEUTRAL] Oh, so, um, 0206-2025. Is that correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alright, thank you so much so, and I think I've got all the information that I need for this claim. I appreciate you for taking the time to answer my call again this is [PII] and have a great day. Bye for now.
[AGENT][POSITIVE] Yes um thank you for calling APM on November.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.